Talk:SAMU

Might be nice if somebody could come up with more solid facts to illustrate the "... arguably on of the best". Like this, it sounds a little bit partisan.

Also, I heard critics from some British press (in Murdock style of course) about the death of Pricess Diana. The argument at that the French had taken hours to bring her to hospital, which is a good illustration of the misconception that "the faster the better" (actually Diana was getting hospital-quality care long before she was de-incarcerated from the wrenches of her car). If someone could come up with a reference to such an article it would be interesting.

An Opposing view

The SAMU (Franco-German) Emergency contrasts sharply with the Anglo-American Model. My perspective is at least as biased as the writer of the SAMU entry, but representing the opposite perspective: that of a residency trained, emergency medicine specialist who is engaged in emergency medicine development work.

Any fair comparison between the French and American pre-hospital systems would have to account for the customs, population density, percent urban, rural and suburban, distribution of specialist and the general quality of health care in the society as a whole, among other intangibles. We are also comparing socialized and private health care systems to some extent, although in the United States, emergency care is provided by law. It would be almost impossible to compare these two systems in their respective home environment. However, a few observations are in order:

The fanciful idea of having a fully equipped hospital respond to emergencies in the pre hospital arena is very attractive to the un-informed. Who would not want a specialist to appear at their door when they have a specialty problem? But then, is that chest pain a heart problem (Cardiologist), or a lung clot (Pulmonary)? And what if the person in pregnant as well?

The fact is, trained Emergency Medical Technicians and Paramedics are capable of stabilizing and transporting the 99% problems that they run into in the field and bring them to the best place for the patient to have definitive care: An emergency department that has an emergency medicine specialist (not generalist who works in an emergency department) who can coordinate the pre-hospital and initial hospital coordination of care.

The fact is that even the most “tuned” pre-hospital physician in a Franco-German model, might see a handful of patients per day and have limited modalities to manage the problem at hand, especially when there are (or maybe) multiple systems involved. An emergency physician is trained for 3 – 4 years after Medical School as a specialist to manage 30-40 patients a day in an environment where ultimately the entire hospital, it’s diagnostic and treatment modalities, can bear down on the problem while definitive care is arranged.

Cardiopulmonary resuscitation can be done by a Paramedic, probably as well as anybody else. There are specific life saving modalities that these technicians are trained in (chest decompression for pneumothorax, endotracheal intubation, surgical airways) which may make a difference in survival. The most complicated life threatening problems need to be managed at an appropriate center. The pulmonary artery injury that Princess Diana died from could have never been fixed in the back of an ambulance in time. It could certainly not make a difference 2 hours later when she finally arrived at the hospital 7 Kilometers away.

Refer to this source:

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijrdm/vol1n2/princess.xml

The real point is that, would you rather your emergency handles by someone who is well trained, manages a large range on complicated emergencies a day in a hospital, or someone who only sees a few people a day in a pre hospital setting, and is either a generalist (not an emergency specialist) or an anesthesiologist...“staying and playing”? And which system ultimately created the best emergency departments and emergency systems? Do we really believe that it is cost effective to put lumbering mobile hospitals in the streets as a matter of routine?

The Franco-German model is beginning to find its way into developing systems in Latin America, before effective emergency single specialty departments are being developed. In this setting, these systems may even actually represent a form of economic triage adding another thorny issue.